TY - JOUR T1 - Embolectomy for stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 316 LP - 321 DO - 10.1136/neurintsurg-2015-011717 VL - 7 IS - 5 AU - Mahesh V Jayaraman AU - M Shazam Hussain AU - Todd Abruzzo AU - Barbara Albani AU - Felipe C Albuquerque AU - Michael J Alexander AU - Sameer A Ansari AU - Adam S Arthur AU - Blaise Baxter AU - Ketan R Bulsara AU - Michael Chen AU - Josser A Delgado-Almandoz AU - Justin F Fraser AU - Don V Heck AU - Steven W Hetts AU - Michael Kelly AU - Seon-Kyu Lee AU - Thabele Leslie-Mawzi AU - Ryan A McTaggart AU - Philip M Meyers AU - Charles Prestigiacomo AU - G Lee Pride AU - Athos Patsalides AU - Robert M Starke AU - Robert W Tarr AU - Don Frei AU - Peter Rasmussen AU - on behalf of the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery (SNIS) Y1 - 2015/05/01 UR - http://jnis.bmj.com/content/7/5/316.abstract N2 - Stroke is the leading cause of adult disability in North America and is the fifth most common cause of death.1 ,2 The natural history of patients with acute ischemic stroke and occlusion of a major intracranial vessel such as the internal carotid artery (ICA), middle cerebral artery (MCA), or basilar artery is dismal, with high rates of mortality and low rates of disability-free survival.3 ,4 We introduce the term ‘Emergent Large Vessel Occlusion (ELVO)’ to describe this clinical scenario.Among acute ischemic stroke, ELVO accounts for the greatest proportion of patients with long-term disability. For the past two decades the use of endovascular therapy has been performed in many centers across the world. The therapies have spanned from infusion of thrombolytic agents5 ,6 to mechanical embolectomy with the introduction of first-generation devices,7 ,8 aspiration-based embolectomy techniques,9 ,10 and the use of stent-retriever based procedures.11 ,12 However, these embolectomy trials were single-arm trials demonstrating safety of the procedure and technique or superiority over another, without direct comparison with standard medical therapy alone.In the past 3 years, several major trials have been published comparing endovascular therapy with standard medical therapy alone. The purpose of this document is to summarize the results of these trials and synthesize the level of evidence supporting the use of embolectomy in patients with ELVO.This document was prepared by the Standards and Guidelines Committee of the Society of NeuroInterventional Surgery, a multidisciplinary society representing the leaders in the field of endovascular therapy for neurovascular disease. The strength of the evidence supporting each recommendation was summarized using a scale previously described by the American Heart Association.Role of intravenous thrombolysisIn 1996 the FDA approved the use of recombinant tissue plasminogen activator (tPA) for the treatment of acute ischemic stroke … ER -